MADELYN LUCILLE FLETCHER-STARK DDS NPI 1528392115

NPI Information

NPI: 1528392115
Provider Name: MADELYN LUCILLE FLETCHER-STARK, DDS
Classification: Dentist - 1223P0700X
Entity Type: Individual

Specialization: Prosthodontics

PECOS Registration: Yes

Address:
8521 GOLF COURSE RD NW STE 116
ALBUQUERQUE, NM
ZIP 87114
Phone: (505) 897-6453
Get Directions

Madelyn Lucille Fletcher-stark, DDS is a prosthodontics dentist in Albuquerque, NM. The provider is that branch of dentistry pertaining to the restoration and maintenance of oral functions, comfort, appearance and health of the patient by the restoration of natural teeth and/or the replacement of missing teeth and contiguous oral and maxillofacial tissues with artificial substitutes. Madelyn Lucille Fletcher-stark, DDS NPI is 1528392115. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

8521 GOLF COURSE RD NW STE 116
ALBUQUERQUE, NM
ZIP 87114-549
Phone: (505) 897-6453

The NPI 1528392115 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA).

The enumeration date for this NPI number is 9/29/2009 and was last updated on 10/17/2017.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	1223P0700X	Dentist	Prosthodontics	DD4508	NEW MEXICO	Yes
2	1223P0700X	Dentist	Prosthodontics	47259	CALIFORNIA	No

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	47259	OTHER	CALIFORNIA	LICENSE NUMBER

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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